Healthcare Provider Details

I. General information

NPI: 1255345435
Provider Name (Legal Business Name): STEPHANIE BURNS WECHSLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

2835 BRANDYWINE RD STE 300
ATLANTA GA
30341-5540
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2593
  • Fax:
Mailing address:
  • Phone: 404-256-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number78802
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number78802
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: